The present invention relates generally to methods and instruments for performing spinal surgery. Specifically, the invention concerns to a sleeve for use with laparoscopic techniques and instruments in spinal surgeries.
Various surgical techniques and instruments have been developed for use in laparoscopic procedures to develop an anatomic space and to permit visualization of the procedures. For example, PCT International Publication No. WO 97/30666 to Zdeblick et al. discloses laparoscopic surgical techniques and instruments for preparing a spinal disc space for implantation of fusion devices or implants. The laparoscopic instrumentation provides a sealed working channel to the disc space through which the disc space is distracted, the vertebral endplates and surrounding discs are reamed, and the vertebral implant inserted, all through a laparoscopic port engaged to the end of the sleeve. In this technique, the instrumentation is placed directly through the tissue through an incision in the skin. One drawback associated with this technique is that the instrumentation has edges, corners or the like that can snag or catch tissue as it is advanced therethrough, increasing tissue trauma and bleeding as a result of the procedure. Another drawback associated with this technique is that although the instrumentation is provided with a sealed working channel, the space between the tissue and the instrument provides an avenue for loss of insufflation pressure.
While the above described instruments and procedures represent various approaches over prior surgical instruments and procedures for spinal surgery, the need for improvements remains. In particular, procedures and instruments are needed that minimize trauma to tissue surrounding the surgical site while allowing surgical procedures to be performed. Also needed are instruments and techniques that maintain the sealed environment of the working space during surgical procedures. The present invention is directed to these needs, among others.
The present invention includes a sleeve that is conformable to a surgical instrument and facilitates insertion of the instrument through tissue during a laparoscopic procedure.
In accordance with one aspect of the present invention there is provided an apparatus for performing laparoscopic surgical procedures through a tissue opening in a patient. The apparatus includes an elongate member with a length having an outer shape along its length. The apparatus also includes a substantially non-expandable sleeve having a proximal end, a distal end wall, and a lumen extending therebetween opening at the proximal end to receive the elongate member. The sleeve is resilient and conformable to the outer shape of at least a distal portion of the elongate member.
In another aspect of the present invention there is provided an apparatus for performing laparoscopic surgical procedures through a tissue opening in a patient. The apparatus includes an elongate member having an outer shape along its length. The apparatus also includes a sleeve with a proximal end, a distal end, and an inner wall defining a lumen extending therebetween. The lumen opens at the proximal end and receives the elongate member. The sleeve is resilient and conformable to the outer shape of at least a distal portion of the elongate member. The sleeve also includes at least one rib extending from the inner wall into the lumen. In a preferred form the at least one rib extends along at least a portion of the length of the sleeve.
In a further aspect of the present invention an apparatus for performing laparoscopic surgical procedures through a tissue opening in a patient is provided. The apparatus includes an elongate member having an outer shape along its length. The apparatus also includes a sleeve having a proximal end, a distal end wall, and an inner wall defining a lumen extending between the proximal and distal ends. The lumen opens at the proximal end to receive the elongate member and is conformable to the outer shape of at least a distal portion of the elongate member. The distal end wall of the sleeve includes means for opening the end wall to allow extension of the elongate member therethrough.
In yet a further aspect of the present invention, there is provided an apparatus for performing laparoscopic surgical procedures through a tissue opening in a patient. The apparatus includes an elongate member having an outer shape along its length. The apparatus includes a sleeve with a proximal end, a distal end, and an inner wall defining a lumen extending between the proximal end and the distal end. The lumen opens at the proximal end to receive the elongate member. A flange member has an opening slidably and sealingly receiving the sleeve member therethrough. The flange member is positionable against the tissue of the patient to seal the tissue opening.
In accordance with a further aspect of the invention, there is provided a method for performing a laparoscopic spinal surgical procedure through skin and tissue of a patient. The method includes: incising the skin and tissue of the patient; providing an elongate member with a length extending between a distal end and a proximal end, the elongate member having an outer shape along its length, and a sleeve having a proximal end, a distal end wall, and a lumen extending therebetween opening at the proximal end receiving at least a distal portion of the elongated member, the sleeve being substantially made from a resilient material and conformable to the outer shape of at least the distal portion of the elongate member; providing a flange member having a central opening receiving the sleeve therethrough; placing the flange member on the skin; and advancing the elongate member and sleeve through the flange member and through the incision to the spine while the sleeve provides a barrier between the tissue and the elongate member. In one form, the flange member seals the space between the tissue and the sleeve.
In accordance with another aspect of the present invention, a method for performing a laparoscopic surgical procedure at a location in a patient is provided. The method includes incising the tissue of the patient; providing an elongate member with a length extending between a distal end and a proximal end, the elongate member having an outer shape along its length, and a sleeve having a proximal end, a distal end wall, and a lumen extending therebetween opening at the proximal end receiving at least a distal portion of the elongate member, the sleeve being resilient and conformable to the outer shape of at least the distal portion of the elongate member; advancing the elongate member and sleeve through the tissue to a position adjacent the location; and advancing the elongate member through the distal end wall of the sleeve to the location.
Other objects, advantages, features, embodiments, aspects and benefits can be discerned from the following written description and the accompanying figures.